Episodios

  • "Burns and Mental Health: A Matched Cohort Study"

    "Burns and Mental Health: A Matched Cohort Study"
    Jul 16 2025

    Reviewed by Reza Lankarani M.D

    ------------------------------------------------------------

    Published online June 2025

    DOI: 10.1097/SLA.0000000000006270

    Annals of Surgery

    ------------------------------------------------------------

    This large-scale matched cohort study investigates the long-term association between burn injuries and mental health hospitalizations over 33 years. Analyzing 23,726 burn patients and 223,626 controls from Quebec, Canada, the study found that burn survivors had a 1.76-fold increased risk of mental health hospitalization compared to controls, with risks persisting up to 30 years post-injury. Severe burns (≥50% body surface area, third-degree burns, skin graft requirements) were linked to higher risks (HR: 2.00–3.29). Notably, burn patients exhibited elevated risks for eating disorders (HR: 3.14), substance use disorders (HR: 2.27), and suicide attempts (HR: 2.42), particularly within the first 5 years after injury.

    Comprehensive Data Linkage:

    - Utilizing population-based registries allowed for accurate tracking of hospitalizations and covariates, including socioeconomic status and preexisting conditions. This reduces selection bias and enhances generalizability within publicly funded healthcare systems.

    Subgroup Analyses:

    - Detailed stratification by burn severity (e.g., body surface area, degree, graft requirements) and mental health outcomes strengthens the validity of associations. For example, severe burns requiring grafts showed a 2-fold higher risk of hospitalization, highlighting the dose-response relationship between injury severity and mental health outcomes .

    -----------------------------

    Comparison with Recent Studies:

    - Short-Term vs. Long-Term Risk:

    Earlier studies (e.g., Bich et al., 2021) reported elevated psychiatric risks up to 5 years post-burn , while this study extends the timeline to 30 years, corroborating longitudinal data from Abouzeid et al. (2022) on chronic mental health decline .

    - Severity Gradient:

    Consistent with Logsetty et al. (2016), severe burns requiring grafts showed the highest mental health risks, emphasizing the need for targeted interventions in this subgroup .

    - Substance Use Disorders:

    The observed 2.14-fold increased risk for alcohol-related hospitalizations aligns with Mason et al. (2017), who linked burn-related chronic pain and opioid prescriptions to substance misuse .

    -------------------------------

    In conclusion, this study exemplifies the value of population-based cohort designs in uncovering the chronic impacts of surgical conditions. It sets a foundation for future research aimed at improving holistic burn care. Burn units should adopt lifelong mental health monitoring protocols, with intensified surveillance in the first 5 years post-injury. Pain management strategies must balance efficacy with addiction prevention to mitigate substance use risks .

    --

    Reza Lankarani M.D

    #burnsandmentalhealth #mentalhealthresearch #burninjurypsychologicalimpact #burnsurvivorsmentalhealth #mentalhealthstudy #cohortstudy #burntraumaandpsychology #psychologicaleffectsofburns #mentalhealthsupport #burninjuryrecovery #mentalhealthawareness #traumaandmentalhealth #psychologicalresilienceburns #burninjurymentalhealthanalysis #healthresearch #mentalhealthoutcomes #burnrehabilitation #mentalhealthinterventions #healthcareresearch



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  • "Comparison Between Endovascular and Surgical Treatment of Acute Arterial Occlusive Mesenteric Ischemia"

    "Comparison Between Endovascular and Surgical Treatment of Acute Arterial Occlusive Mesenteric Ischemia"
    Jul 15 2025

    Reviewed by Reza Lankarani MD

    -------------------------

    World Journal of Emergency Surgery

    https:/doi.org/10.1186/s13017-025-00616-4

    This prospective observational substudy of the AMESI cohort provides valuable insights into the complex management of acute arterial occlusive mesenteric ischemia (AMI), specifically superior mesenteric artery (SMA) occlusion. Crucially, the authors rigorously account for baseline severity of illness (APACHE II, SOFA, lactate, vasopressor/ventilator needs), a major confounder often inadequately addressed in prior literature.

    Their sophisticated statistical approach, including multivariable logistic regression adjusted for key severity markers, robustly demonstrates that the apparent mortality benefit of endovascular therapy in unadjusted analysis (15.7% vs. 45.8%) is largely attributable to patient selection favoring less severely ill patients for endovascular intervention.

    The finding that neither initial treatment modality (endovascular vs. surgical) nor the performance of revascularization itself was an independent predictor of mortality after adjustment challenges simplistic interpretations of previous retrospective data and guideline recommendations.

    The subgroup analysis of endovascular monotherapy effectiveness (66.6% success rate) and its stark mortality difference (2.9% effective vs. 41.2% insufficient) provides clinically relevant granularity, highlighting the critical importance of patient selection for this approach.

    The explicit inability to identify reliable time thresholds or lactate cut-offs (beyond normal ranges) for predicting endovascular success underscores the complexity of AMI pathophysiology and the limitations of isolated biomarkers or symptom duration in guiding therapy.

    The study's significant strengths are its prospective nature, adjustment for illness severity, multicenter representation, and transparent reporting of limitations.

    However, key limitations acknowledged by the authors must be considered: inherent selection bias in treatment assignment within an observational design, relatively small subgroup sizes (especially for failed endovascular monotherapy, n=17), potential heterogeneity in treatment protocols across centers, and missing data for severity scores in some patients.

    Despite these limitations, the study makes a substantial contribution by shifting the paradigm: it compellingly argues that the choice between endovascular and surgical intervention should prioritize the patient's overall physiological condition and the etiology of occlusion (embolism vs. thrombosis) over rigid adherence to symptom duration thresholds. It sets a crucial precedent for future studies by emphasizing the absolute necessity of detailed reporting and adjustment for baseline severity, symptom duration, and AMI subtype to generate truly evidence-based management guidelines.

    -----------------------------------

    Reza Lankarani M.D

    #endovasculartreatment #surgicaltreatment #arterialocclusivemesentericischemia #acutemesentericischemia #vascularsurgery #minimallyinvasivesurgery #mesentericischemiamanagement #endovasculartherapy #surgicalintervention #mesentericartery #ischemiadiagnosis #vascularintervention #emergencybowelischemia #treatmentcomparison #mesentericischemiaoutcomes



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  • "Vagilangelo, Innovation or Exploitation in Women’s Health Deep Dive Podcast"

    "Vagilangelo, Innovation or Exploitation in Women’s Health Deep Dive Podcast"
    Jul 13 2025
    The provided sources, primarily critiques from an OBGYN and health disparities researcher, Dr. Reza Lankarani, highlight significant concerns regarding the Vagilangelo® procedure and the broader landscape of cosmetic gynecology, particularly in the context of medical tourism and training in Arab countries. The central theme revolves around the tension between profit-driven healthcare and patient safety, arguing that the commercialization of uncertainty in women's health is exploitation, not innovation.1. The Vagilangelo® Procedure: Unsubstantiated Claims and Evidence DeficitThe Vagilangelo® procedure, marketed as a revolutionary vaginal rejuvenation technique, aims to restore "natural vaginal angulation" through internal suturing and platelet-rich plasma (PRP) injections. However, the sources assert that its claims are largely unsubstantiated by scientific evidence.Lack of Peer-Reviewed Validation: Despite claims of "77% satisfaction," Dr. Lankarani's critical review notes: "High satisfaction rates cited are anecdotal... Clinical trials comparing it to established methods would significantly strengthen its standing." The procedure lacks "zero randomized controlled trials," "no longitudinal safety data," and "absence of objective outcome measures (e.g., validated sexual function scales)."Unproven Biological Mechanisms: The efficacy of PRP for vaginal sensitivity lacks "tissue-specific evidence," and its growth factor concentrations and injection protocols are not standardized. This "scientific overreach" contrasts with established therapies that have documented effects.Inadequate Structural Correction: Marketing materials state Vagilangelo® provides "less tightening than traditional vaginoplasty," making it unsuitable for significant prolapse or laxity, positioning it as a "solution" for problems it cannot adequately address.Unquantified Risks: Unlike traditional surgeries with documented complication rates (e.g., vaginoplasty stenosis rates: 5–15% at 5 years), Vagilangelo® lacks published data on intraoperative risks, long-term safety, or pain management. The use of internal sutures poses theoretical risks of "urethral/bladder injury" and "nerve damage."2. The Exploitative Ecosystem: Medical Tourism and Predatory TrainingThe sources heavily criticize the "exploitative cosmetic surgery tourism" and "unethically trained practitioners" associated with procedures like Vagilangelo®, particularly targeting vulnerable women in low-resource settings like Bahrain.Medical Tourism's Hidden Costs: Bahrain's experience shows that its tertiary centers absorb significant costs (175,000 USD annually) treating complications from cosmetic tourism, mostly infections and implant failures. "All-inclusive packages" typically exclude meaningful postoperative care, leading to "patient abandonment" and an "economic drain" on local healthcare systems.Unethical Training Paradigms: The rise of "short-course 'fellowships'" (e.g., 3-5 day "certification" programs in Arab countries) enables this crisis. These programs lack "standardized curricula" and bypass the 1-2 years of supervised training required for legitimate surgical fellowships. They are accused of "targeting vulnerable populations" and allowing "underqualified surgeons operating on poor women," which is deemed "ethical malpractice."Commercialization of Insecurity: Vagilangelo® marketing is seen as violating core bioethical principles by prioritizing profit over documented clinical benefit. Patients cannot provide meaningful consent due to a lack of outcome data, and the high cash-pay cost ($3,000+) excludes low-income women who might need functional repair.3. Ethical Violations and Health DisparitiesThe commercialization of procedures without robust evidence is seen as contributing to global health inequity and ethical failures.Autonomy Violation: Patients cannot provide meaningful consent without comprehensive, evidence-based information on risks and benefits.Justice Failure: The high cost excludes low-income women who might benefit more from affordable, evidence-based functional repairs.Beneficence Abandonment: The emphasis on profit over documented clinical benefit is a betrayal of the medical principle of beneficence.Regressive Healthcare Subsidy: Public hospitals bear the burden of complications from offshore cosmetic procedures, effectively subsidizing a profit-driven industry.4. Policy Recommendations: Toward Ethical PracticeThe sources propose a multi-faceted approach to address these issues, emphasizing regulatory harmonization, patient safety integration, and ethical commercialization.Evidence and Regulation Reform: This includes an "immediate moratorium on Vagilangelo® marketing pending RCTs," standardization of outcome measures by professional bodies (e.g., ACOG/FIGO), and "FDA-equivalent oversight of PRP preparation protocols."Training and Equity Measures: Recommendations include a "global ban on <3-month cosmetic surgery 'fellowships'," mandatory ...
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  • Vagilangelo, Innovation or Exploitation in Women’s Health?

    Vagilangelo, Innovation or Exploitation in Women’s Health?
    Jul 11 2025
    Authored by Reza Lankarani MD Section 1: IntroductionCosmetic gynecology is a rapidly growing field, fueled by technological advances and increasing societal interest in aesthetic and functional modifications of female genital anatomy. Among these innovations, Vagilangelo® is heavily marketed as a revolutionary, minimally invasive vaginal rejuvenation technique promising to restore the "natural vaginal angle" disrupted by childbirth or aging, with purported benefits in sexual satisfaction and sensitivity.However, beneath its glossy promotional veneer lies a complex web of scientific uncertainties, ethical dilemmas, and health equity challenges. Today, we will dissect these layers with academic rigor and clinical insight to provide you, our listeners, with a nuanced understanding of Vagilangelo®’s place in modern gynecological practice.Section 2: Critical Scientific Weaknesses and Evidence GapsThe most significant issue surrounding Vagilangelo® is the stark absence of rigorous clinical evidence. Unlike well-established vaginal rejuvenation procedures documented in peer-reviewed journals such as The Journal of Sexual Medicine or the American Journal of Obstetrics and Gynecology, Vagilangelo® relies almost exclusively on manufacturer websites and patient testimonials for its claims. There are no Level I to III studies—meaning no randomized controlled trials, cohort studies, or even case series—to definitively prove its efficacy or safety.As Dr. Reza Lankarani, a respected clinical researcher, has emphasized, this lack of high-quality evidence is a glaring flaw that undermines the procedure’s credibility. In contrast, other less invasive modalities such as laser or radiofrequency (RF) therapies for vaginal rejuvenation have at least preliminary clinical data supporting their use.Furthermore, the biological rationale for the use of PRP injections in Vagilangelo® is problematic. Platelet-Rich Plasma has demonstrated efficacy in some medical fields, such as orthopedics, but its role in vaginal tissue regeneration and sensitivity enhancement remains unproven. Scientific literature, including recent studies published in journals like Cells in 2023, highlights the variability in PRP composition, the lack of standardized injection protocols, and conflicting results regarding its benefits for vaginal lubrication or sensitivity.Beyond these biological uncertainties, Vagilangelo® does not adequately address key structural issues. The procedure explicitly avoids correction of pelvic floor musculature or significant ligamentous laxity, which are often involved in pelvic organ prolapse or functional disorders. Marketing materials themselves acknowledge that Vagilangelo® offers less tightening than traditional vaginoplasty—rendering it unsuitable for patients with moderate to severe pelvic floor dysfunction.Finally, the risks associated with Vagilangelo® are frequently downplayed. Although marketed as “non-invasive,” internal suturing near delicate pelvic nerves and organs carries inherent risks such as suture erosion, chronic pain (dyspareunia), and urinary symptoms (dysuria). PRP injections may also cause complications like infection, scarring, or paradoxical pain. Post-procedural care often requires sexual abstinence for several weeks, mirroring surgical aftercare, yet standardized protocols for managing complications are lacking.---Section 3: Comparative Limitations Against Established AlternativesIn the landscape of vaginal rejuvenation, Vagilangelo® occupies an ambiguous niche. It is less invasive than traditional surgical options like vaginoplasty but more invasive than energy-based modalities such as laser or radiofrequency therapies.Energy-based devices have the advantage of inducing collagen remodeling with documented histological evidence and relatively low risk profiles, without the need for suturing. Vaginoplasty, on the other hand, is the gold standard for correcting severe anatomical defects, with decades of outcome and safety data.Vagilangelo® lacks the evidence base, functional scope, and risk-mitigation protocols of these traditional methods. It is neither a substitute for surgery nor a clearly superior alternative to energy-based treatments. This “middle ground” status complicates clinical decision-making and patient counseling.---Section 4: Ethical Concerns and Commercial ExploitationTurning to the ethical dimension, Vagilangelo® raises serious concerns about the commercialization of women’s health insecurities. The procedure is heavily marketed using terms like “revolutionary” and “groundbreaking,” which can create unrealistic expectations among vulnerable populations—particularly postpartum women who may be distressed by natural anatomical changes after childbirth.This marketing strategy violates ethical standards such as the American Medical Association’s Code of Medical Ethics §8.063, which stresses the importance of providing patients with realistic ...
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  • GLP-1 Agonists Versus Bariatric Surgery: A Paradigm Shift?

    GLP-1 Agonists Versus Bariatric Surgery: A Paradigm Shift?
    Jul 8 2025

    GLP-1 Agonists Versus Bariatric Surgery: A Paradigm Shift?

    1.1. Host: Obesity and diabetes management are seeing a seismic shift, Dr. Lankarani, with GLP-1 agonists like semaglutide making headlines. Is metabolic surgery becoming obsolete, or do these drugs complement existing surgical interventions?

    1.2. Guest: It's a critical juncture. While GLP-1 drugs offer noninvasiveness and 15–22% weight loss, bariatric surgery still outperforms in durability—delivering over 25% weight loss and diabetes remission in 80% of patients, as shown in STAMPEDE trial's 10-year data, which all these databases gatheredby by Dr Reza Lankarani, General Surgeon and Surgical Innovation Lead, Curator and Founder of Surgical Pioneering Newsletter and Podcast Series.

    1.3. Host: Yet, for some patients—especially those with BMI 30–35 or unwilling to undergo surgery—GLP-1s seem transformative. Real-world studies like SURMOUNT-4 highlight better adherence and lower complication rates. How should clinicians weigh these benefits against surgical options?

    1.4. Guest: Patient selection is key. Surgery addresses metabolic drivers beyond appetite suppression, but GLP-1s provide a cost-effective, accessible route for those at lower risk. The real challenge lies in balancing short-term drug trial data with proven surgical longevity.

    1.5. Host: So, as these therapies evolve, will we see more combination protocols or a clearer division between surgical and pharmacologic candidates?

    1.6. Guest: Combination strategies may soon emerge, particularly as we integrate longer-term GLP-1 outcomes. Ultimately, multidisciplinary teams must tailor approaches based on comorbidities, prior weight loss attempts, and patient preference.

    #generalsurgerycontroversies #surgicalethicsdebates #medicalmalpracticecases #invasivevsminimallyinvasivesurgery #surgicalinnovationcontroversies #patientsafetyinsurgery #surgicalguidelinesdebate #surgeonaccountabilityissues #healthcarepolicysurgery #surgicaltrainingcontroversies #postoperativecomplicationissues #surgicaltechnologydebates #surgeon-patientcommunication #surgicalriskmanagement #recentsurgicalscandals #surgicalPioneering glp-1 agonists #metabolic surgery #obesity management #weight loss strategies #type 2 diabetes treatment #bariatric procedures #gut hormones #semaglutide #liraglutide #wegovy #satiety regulation #appetite control #diabetes and obesity #future of obesity treatment #surgical vs medical obesity options



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  • "Top 5 Controversies in General Surgery for 2024–2025"

    "Top 5 Controversies in General Surgery for 2024–2025"
    Jul 7 2025
    Authored by Reza Lankarani, M.D General surgery faces intense debates for 2024–2025, including GLP1 agonists vs. bariatric surgery, bridging anticoagulation in urgent cancer surgery, timing of hip fracture repair in heart failure patients, robotic vs. laparoscopic surgery costs and benefits, and opioid-sparing pain protocols. Key issues revolve around clinical outcomes, evolving technology, cost-effectiveness, patient safety, and ethical challenges in modern surgical care. 1. GLP-1 Agonists Versus Bariatric Surgery: A Paradigm Shift? 1.1. Host: Obesity and diabetes management are seeing a seismic shift, Dr. Lankarani, with GLP-1 agonists like semaglutide making headlines. Is metabolic surgery becoming obsolete, or do these drugs complement existing surgical interventions? 1.2. Guest: It's a critical juncture. While GLP-1 drugs offer noninvasiveness and 15–22% weight loss, bariatric surgery still outperforms in durability—delivering over 25% weight loss and diabetes remission in 80% of patients, as shown in STAMPEDE trial's 10-year data, which all these databases gatheredby by Dr Reza Lankarani, General Surgeon and Surgical Innovation Lead, Curator and Founder of Surgical Pioneering Newsletter and Podcast Series. 1.3. Host: Yet, for some patients—especially those with BMI 30–35 or unwilling to undergo surgery—GLP-1s seem transformative. Real-world studies like SURMOUNT-4 highlight better adherence and lower complication rates. How should clinicians weigh these benefits against surgical options? 1.4. Guest: Patient selection is key. Surgery addresses metabolic drivers beyond appetite suppression, but GLP-1s provide a cost-effective, accessible route for those at lower risk. The real challenge lies in balancing short-term drug trial data with proven surgical longevity. 1.5. Host: So, as these therapies evolve, will we see more combination protocols or a clearer division between surgical and pharmacologic candidates? 1.6. Guest: Combination strategies may soon emerge, particularly as we integrate longer-term GLP-1 outcomes. Ultimately, multidisciplinary teams must tailor approaches based on comorbidities, prior weight loss attempts, and patient preference. 2. Bridging Anticoagulation in Cancer Surgery: Bleeding or Stent Risk? 2.1. Host: Let’s move to urgent cancer surgery in patients with recent coronary stents. The debate over bridging with IV cangrelor versus aspirin alone is intensifying. Where does current evidence stand, and how do we reconcile registry data with randomized trials? 2.2. Guest: Registry data suggest bridging increases bleeding and cost without clear benefit, especially with modern drug-eluting stents lowering thrombosis risk to under 1% after 30 days. The CHAMPION PHOENIX trial did show cangrelor’s rapid reversibility, but at a steep $5,000 per dose. 2.3. Host: Still, in patients with high-risk anatomy, like left main stents, some guidelines support bridging. Is this a case where individualized anatomy and oncology timelines should override blanket protocols? 2.4. Guest: Precisely. While guidelines now favor aspirin-only post 1 month, nuanced decisions must consider stent location, cancer urgency, and patient-specific risks. Value-based care demands we weigh bleeding complications against rare but catastrophic stent thrombosis. 2.5. Host: Do you anticipate consensus shifting as more real-world data accumulates, or will this remain a case-by-case decision? 2.6. Guest: It’s likely to stay individualized, but ongoing registry analyses and RCTs will refine protocols—perhaps with newer reversal agents or tailored risk calculators. 3. Timing Hip Fracture Surgery in Acute Heart Failure Patients 3.1. Host: Hip fractures in frail patients with acute heart failure present a classic timing dilemma. Should we delay surgery for diuresis and stabilization, or proceed immediately to minimize complications like delirium and pneumonia? 3.2. Guest: It's a clinical tightrope. Delay advocates cite quadrupled mortality in unoptimized heart failure, aligning with ACS-TQIP guidelines recommending up to 48 hours for stabilization, especially if oxygen needs and fluid overload are significant. 3.3. Host: Yet, the HIP ATTACK trial supports expedited surgery, showing lower mortality and fewer adverse events with delays under 24 hours. How do teams decide, especially when physiologic status is borderline? 3.4. Guest: Fluid balance thresholds and real-time monitoring are critical. Multidisciplinary protocols, involving cardiology and anesthesia, help stratify who benefits from delay versus urgent operation. Mortality heatmaps increasingly guide these nuanced calls. 3.5. Host: Could AI-driven risk calculators or remote monitoring soon tip the scales by predicting which patients will truly benefit from delay? 3.6. Guest: Absolutely. As decision-support tools mature, they’ll help personalize timing, integrating more granular physiologic data than blanket ...
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  • "Effects of the lavage through fistula in treatment of spontaneous esophageal rupture by combined thoracoscopic and gastroscopic management"

    "Effects of the lavage through fistula in treatment of spontaneous esophageal rupture by combined thoracoscopic and gastroscopic management"
    Jul 6 2025

    "Effects of the lavage through fistula in treatment of spontaneous esophageal rupture by combined thoracoscop and gastroscop "

    Reviewed by Reza Lankarani M.D

    --------------------------------

    World Journal of Emergency Surgery

    Published: 07 June 2025

    https://doi.org/10.1186/s13017-025-00630-6

    --------------------------------

    This retrospective study (2014-2024, n = 24) evaluates a novel lavage-drainage technique for spontaneous esophageal rupture (SER/Boehhaave's syndrome).

    Patients undergoing VATS debridement/drainage were divided into:

    1. Lavage-Drainage Group (n = 11): Gastroscopically guided placement of a nasogastric tube through the esophageal fistula for continuous irrigation (iodinated saline) + standard thoracic/mediastinal drainage.

    2. Drainage Group (n = 13): Standard VATS debridement/drainage alone.

    No Difference: Operative time, ICU/hospital stay, mechanical ventilation duration.

    The authors conclude that fistula lavage enhances drainage efficiency, reduces inflammation, and improves SER prognosis but requires cost optimization.

    --------------------------------

    Comparison to Recent Literature:

    VATS as Standard: Confirms VATS as the preferred minimally invasive approach for stable SER patients, aligning with consensus (Elliott et al., Surg Endosc 2019; Haverman et al., Surg Endosc 2011).

    Beyond Basic VATS Drainage: Addresses limitations of simple VATS drainage (tube blockage, inadequate clearance) highlighted by Yu et al. (J Int Med Res 2018). The lavage technique offers a solution similar in spirit to "two-tube" methods but with direct fistula access.

    Lavage Concept Supported: Hanajima et al. (J Thorac Dis 2021) also reported success with VATS-guided lavage/drainage (lower mortality, shorter hospital stay in historical controls), providing external validation for the lavage concept, though without the gastroscopic fistula cannulation.

    --------------------------------

    Conclusion & Significance:

    Huang et al. present a promising technical advancement in managing SER. The combined thoracoscopic-gastroscopic lavage-drainage technique demonstrates potential for reducing mortality and severe complications compared to standard VATS drainage alone, particularly in delayed presentations. Its strength lies in directly addressing a key failure mode of traditional drainage (tube blockage) through enhanced debridement and controlled fistula management.

    However, the small, retrospective, single-center nature of the study is a major limitation. The observed benefits, while clinically compelling, require confirmation in larger, prospective, multi-center studies with longer follow-up and detailed cost-effectiveness analyses. This technique represents a valuable addition to the "damage control" armamentarium for SER but should be considered within the context of available expertise and resources due to its complexity and higher initial cost.

    --------------------------------

    Reza Lankarani M.D



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  • "Standardizing the Definition of Each Colon Cancer Segment: Delphi Consensus"

    "Standardizing the Definition of Each Colon Cancer Segment: Delphi Consensus"
    Jul 5 2025

    Reviewed by Reza Lankarani M.D

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    Diseases of the Colon & Rectum

    DOI: 10.1097/DCR.0000000000003739

    Published online:June 2025

    ------------------------------------------------------------

    This international Delphi consensus study addresses a critical gap in colorectal oncology: the lack of standardized anatomical definitions for colon cancer segments. Its primary strength lies in its rigorous methodology and global representation. The three-round Delphi process engaged 295 colorectal surgery experts from 28 countries across four continents, ensuring diverse perspectives and high retention rates (91% completed round 2; 89% all three rounds). The structured approach—using a 9-point Likert scale, predefined consensus thresholds (≥70% for strong agreement), iterative refinement, and a final consensus conference—enhances the validity and reliability of the findings. The resulting definitions leverage clinically accessible landmarks (e.g., ileocecal valve for cecum, disappearance of teniae for sigmoid colon) and introduce a practical "10-cm rule" for flexure boundaries, balancing anatomical precision with surgical applicability. Crucially, the study clarifies responsibility: surgeons should define tumor location intraoperatively (98% consensus), challenging current ICD coding priorities.

    However, the study also reveals persistent challenges requiring further resolution. While strong consensus (>90%) was achieved for 7/8 colon segments (cecum to sigmoid), significant geographical discordance emerged regarding the rectosigmoid concept. Experts from the Americas/Europe overwhelmingly supported abolishing the term (75-76% consensus), favoring classification as upper rectal cancer, whereas Asian experts favored retaining it (63% consensus), reflecting entrenched regional guidelines (e.g., Japanese classifications). Additionally, defining overlapping segment tumors achieved only moderate consensus (64%), with the "center of the lesion" approach lacking universal endorsement. These discrepancies highlight the influence of regional practices and underscore that anatomical definitions alone may not resolve all clinical dilemmas, particularly where embryological boundaries (e.g., hindgut vs. midgut) influence treatment paradigms. Future validation correlating these definitions with oncologic outcomes is essential.

    Over۷all, this study provides a much-needed, methodologically robust foundation for standardizing colon segment definitions globally, enhancing registry data comparability and research validity. Its key limitation is unresolved regional divergence on the rectosigmoid junction and overlapping lesions, indicating areas for targeted interdisciplinary research integrating anatomical, molecular, and outcome data.

    ------------------------------------------------------------

    Reza Lankarani M.D

    #colonanatomy #coloncancersegments #colorectalanatomy #ascendingcolon #descendingcolon #transversecolon #sigmoidcolon #taeniacoli #cecum #largeintestineanatomy #colonsegmentdefinitions #colorectalcancerstaging #intestinalsegmentpathology #colonsegmenteducation #gastrointestinalanatomy



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